Nonpharmacological Therapeutic Techniques to Decrease Agitation in Geriatric Psychiatric Patients With Dementia

Mitchell, Ann M.; Chiappetta, Laurel; Boucek, Lynn; Cain, Michelle; Patterson, Georgia; Owens, Kim Hensley; Herisko, Camellia; Stark, Kirsti Hetager

doi:10.3928/00989134-20141014-02

Cited by 16 publications

(40 citation statements)

References 19 publications

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“…Interventions directly targeting the symptoms of disorientation and/or derealization that increase the risk of disruptive behaviors among patients suffering from cognitive impairments might be interesting and promising alternatives. For example, architectural changes in wards, such as multisensory rooms or senses-based interventions, including Snoezelen therapy or a "controlled multisensory environment," aimed at alleviating the symptoms of disorientation and/or derealization through sensory stimuli seem promising [63,64]. Including a patient's relatives in clinical discussions and decisions is also an alternative for the care of patients with cognitive impairments [61,65].…”

Section: Implications For Clinical Practicementioning

confidence: 99%

Prevalence and risk factors for seclusion and restraint in old-age psychiatry inpatient units

et al. 2021

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Background and objectives Coercion in psychiatry is legally tolerated as a last resort. The reduction of the use of coercion is a shared goal of hospital administrators, medical and nursing staff and representatives of patients and families but requires the identification of risk factors for coercion. These risk factors in geriatric psychiatric inpatient settings are not well known, especially regarding seclusion. Through examining the prevalence of coercion and patients’ characteristics, this study aims to identify risk factors for coercion in elderly people. Methods The use of coercion in the geriatric psychiatry division of Geneva University Hospital in 2017 was retrospectively analyzed. The incidence rate ratios were estimated with multivariable Poisson regressions to assess risk factors for coercion. Results Eighty-one of 494 patients (16.4%) experienced at least one coercive measure during their stay (mainly seclusion). The risk factors for coercion were younger age, male gender, being divorced or married, cognitive disorders, high item 1 of the Health of the Nation Outcome Scales (HoNOS) score (overactive, aggressive, disruptive or agitated behavior) at admission, previous psychiatric hospitalizations and involuntary referrals from the emergency department. Other disorders and global HoNOS scores were not associated with the use of coercion. Conclusion Higher risks of coercion were outlined in men with cognitive disorders, agitated behaviors, and previous psychiatric hospitalizations. They differed from those observed in younger adults in terms of age, civil status, disorders, global HoNOS scores and referrals. Therefore, geriatric psychiatric populations should be specifically investigated for the development of interventions aiming coercion reduction.

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Section: Implications For Clinical Practicementioning

confidence: 99%

Prevalence and risk factors for seclusion and restraint in old-age psychiatry inpatient units

et al. 2021

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“…Mitchell, Chiappetta (17) This article presents results from a quality improvement pilot project that examined the usefulness of a specially designed, multisensory room intervention which included music for inpatients in a psycho-geriatric treatment facility who had mild to moderate agitation. They found that using the multi-sensory room decreased agitation as measured by the Pittsburgh Agitation Scale (PAS) for up to an hour in all sub-scales with the exception the aggression subscale.…”

Section: Authorsmentioning

confidence: 99%

“…Alternatively, non-pharmacological treatment is based on high levels of patient and caregiver satisfaction, and reduced behavioural symptoms with minimal risk and adverse reactions (14,15). The most common non-pharmacological therapies are music therapy, aromatherapy and massage, laughter, structured activities, animal-assisted interventions, environmental interventions, simulated presence, dance movement, art, and combination therapies (16,17).…”

Section: Introductionmentioning

confidence: 99%

Systematic review of evidence underpinning non-pharmacological therapies in dementia

Olley

Morales

2018

Aust. Health Review

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Dementia is one of the most common illnesses worldwide, and is one of the most important causes of disability in older people. Currently, dementia affects over 35million people around the globe. It is expected that this number will increase to 65.7million by 2030. Early detection, diagnosis and treatment to control the principal behaviour symptoms may help reduce these numbers and delay the progression to more advanced and dangerous stages of this disorder with resultant increase quality of life for those affected. The main goal of the present systematic literature review was to examine contemporary evidence relating to non-pharmacological therapy in the treatment of dementia. To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used. This study identified the five most common behaviours in patients with dementia as aggression, wandering, agitation, apathy and sleep disturbances. Two non-pharmacological therapies were the most studied treatment: music therapy and aromatherapy. Ten other non-pharmacological therapies were also identified, but these lack a sufficient evidence-base. Although all the therapies identified could be used as part of the treatment of behavioural symptoms, there is insufficient evidence relating to the indications, appropriate use and effectiveness of these therapies to apply in each behavioural treatment. Thus, the present study has demonstrated a significant research gap. Despite the widespread use of many different types of therapies, there is limited evidence regarding the efficacy of non-pharmaceutical therapies deployed in the management of behaviours of concern manifested by some people who suffer with dementia in all its forms. This systematic review examines contemporary evidence from the literature to determine whether there is an evidence base available that would underpin the use of these therapies. This report on a PRISMA systematic review of the available literature demonstrates that only two therapies have some evidence to underpin the use of these non-pharmaceutical therapies and that a significant research gap is exists. The implications for practitioners is that significant research effort is required to determine the efficacy of many of the therapies that are currently deployed, and thus many of the therapies used lack an evidence base at this time.

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“…Although most of the reviewed articles focused on non-pharmacological interventions, it is noted that both pharmacological and non-pharmacological interventions are widely used concurrently in many healthcare facilities [3]. While pharmacological interventions are undoubtedly needed in some cases, the benefit of decreasing the risk of serious adverse drug effects is noted related to the use of nonpharmacological interventions [8]. A complementary pharmacological intervention would include frequent medication reviews to reduce the administration of unnecessary and inappropriate medications [9].…”

Section: Strengths and Limitations Of Selected Referencesmentioning

confidence: 99%

Addressing Adventitious Behaviors Associated with Dementia

Kemerer

2018

PNIN

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Dementia is an insidious disease process that prevents an individual from making sense of environmental circumstances. Cognitively impaired patients are at increased risk for falls, skin integrity issues, accidents, and wandering behaviors. Yet, as the understanding of this disease process and the behaviors exhibited by the dementia patient grows, there is a new focus on individualizing care and attempting to manage adverse behaviors in a holistic fashion utilizing mainly nonpharmacological interventions. It has been shown that the evidence-based best practices related to mitigating adventitious behaviors in the geriatric population diagnosed with dementia are associated to nonpharmacological interventions. Utilization of technology in the form of computers to implement music therapy, reminiscence therapy, and occupational recreational therapy was the selected evidence-based best practice to implement. The aim of the work is to show non-pharmacological interventions as an inseparable and complementary method of pharmacological treatment of working with people with dementia. (JNNN 2018;7(1):40-45) Key Words: dementia, nonpharmacological interventions, adventitious behaviors StreszczenieDemencja jest podstępnym schorzeniem, które uniemożliwia chorym zrozumienie warunków środowiskowych. Pacjenci z zaburzeniami poznawczymi narażeni są na zwiększone ryzyko wystąpienia upadków, problemów skórnych, wypadków i zachowań wędrownych. Wraz ze wzrostem zrozumienia tego procesu chorobowego i zachowań przejawianych przez osoby chore, nowe podejście koncentrować się powinno na indywidualizacji opieki i próbach radzenia sobie z niepożądanymi zachowaniami w sposób całościowy, wykorzystując głównie interwencje niefarmakologiczne. Wykazano, że najlepsze praktyki oparte na dowodach, związanych z łagodzeniem przypadkowych zachowań w populacji geriatrycznej z rozpoznaną demencją, wiążą się z niefarmakologicznymi interwencjami. Wykorzystanie technologii w postaci komputerów do realizacji muzykoterapii, terapii wspomnień i rehabilitacji zajęciowej były wybrane najlepszą praktyką opartą na dowodach. Celem pracy jest ukazanie interwencji niefarmakologicznych jako nieodłącznej i uzupełniającej podstawowe leczenie farmakologiczne metody pracy z osobami z demencją. (PNN 2018;7(1):40-45) Słowa kluczowe: demencja, metody niefarmakologiczne, uboczne zachowania

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Nonpharmacological Therapeutic Techniques to Decrease Agitation in Geriatric Psychiatric Patients With Dementia

Cited by 16 publications

References 19 publications

Prevalence and risk factors for seclusion and restraint in old-age psychiatry inpatient units

Prevalence and risk factors for seclusion and restraint in old-age psychiatry inpatient units

Systematic review of evidence underpinning non-pharmacological therapies in dementia

Addressing Adventitious Behaviors Associated with Dementia

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